Primary and Specialty Medical Care Among Ethnically Diverse, Older Rural Adults With Type 2 Diabetes: The ELDER Diabetes Study

PURPOSE: Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes. METHODS: Data were drawn from a cross-sectional face-to-face survey of randomly selected African American (n=220), Native American (n=181), and white (n=297) Medicare beneficiaries > or =65 years old with diabetes in 2 rural counties in central North Carolina. Participants were asked about utilization of a primary care doctor and of specialists (nutritionist, diabetes specialist, eye doctor, bladder specialist, kidney specialist, heart specialist, foot specialist) in the past year. FINDINGS: Virtually all respondents (99.0%) reported having a primary care doctor and seeing that doctor in the past year. About 42% reported seeing a doctor for diabetes-related care. On average, participants reported seeing 2 specialists in the past year, and 54% reported i seeing >1 specialist. Few reported seeing a diabetes specialist (5.7%), nutritionist (10.9%), or kidney specialist (17.5%). African Americans were more likely than others to report seeing a foot specialist (P < .01), while men were more likely than women to have seen bladder specialist (P = .02), kidney specialist (P = .001), and heart specialist (P = .004), after adjusting for potential confounders. Predictors of the number of specialists seen include gender, education, poverty status, diabetes medication use, and self-rated health. CONCLUSIONS: These data indicate low utilization of specialty diabetes care providers across ethnic groups and reflect the importance of primary care providers in diabetes care in rural areas.     

湖南省学生生长发育长期变化趋势分析

目的了解湖南省儿童青少年生长发育长期变化趋势,为开展学校卫生保健工作提供资料.方法分析2000年湖南省7～22岁学生体质调研资料,并与1985年进行比较.结果城市男女生、农村男女生身高分别平均增长了2.9 cm,2.4 cm,2.3 cm和1.5 cm,体重分别平均增长了4.7 kg,2.6 kg,1.8 kg和0.6 kg.城市男女学生胸围分别平均增长了1.1 cm和2.6 cm,农村男生胸围平均减少0.9 cm,农村7～9岁女生胸围下降明显.城乡各年龄组男女学生肺活量指数均显著下降(P＜0.01).农村学生形态指标发育高峰年龄明显提前.结论湖南省学生身高、体重发育呈现出长期增长趋势,其增长值小于同期全国平均水平.应加强学生体育锻炼,注意改善农村学生营养,青春期卫生教育应始于小学高年级.     

儿童频繁性眨眼101例的矫治效果

目的:观察分析综合疗法矫治儿童频繁眨眼的疗效。方法:采用心理疗法、药物、手术等去除病因后,均给以针灸等综合疗法,治疗频繁眨眼患儿101例(202眼)。结果:在去除病因后均在心理治疗的诱导下,针刺新明II、攒竹、四白穴,针刺2次频繁眨眼症状消失者68例(67.3%),5次治愈者31例(30.6%),10次治愈者2例(1.4%)。结论:综合疗法是矫治儿童频繁眨眼的有效方法。     

临床瞳孔检查新进展

瞳孔每时每刻处于动态的变化之中,因此瞳孔的检查也是一个较为复杂的过程。随着对屈光手术质量要求的日益提高,特别是暗适应下瞳孔的大小往往在一定程度上可能决定着术后质量的好坏,因此暗适应下瞳孔的精确测量变得尤为重要。现对近年来涌现的瞳孔检查新技术作一简要概括。     

上斜肌前部前徙术治疗上斜肌麻痹的外旋斜的研究

目的 观察术中可调整缝线的上斜肌前部前徙术治疗上斜肌麻痹的外旋斜的效果。方法 对6例(9眼)外旋斜患者(其中双眼外旋斜和单眼外旋斜各3例)行此术式，在术前、术中、术后1周分别行双马多氏杆检查第一眼位的主观旋转斜。分析旋转斜度与手术量的关系及治疗效果。结果 6例患者术前都存在正前方及下方双眼复视症状，第一眼位的外旋斜5～15。，平均10．5。。术毕双马多氏杆检查第一眼位为0^o～内旋斜5^o,平均内旋斜3．7^o。术后所有患者正前方及向下看复视症状消失，术后1周为外旋2^o～内旋4^o,平均内旋1．4^o。其中2例患者术后7个月复诊，一例外旋斜3^o；另一例为旋转斜0^o，都未出现明显复视症状。结论 术中可调整缝线的上斜肌前部前徙术是一种安全可靠的矫正上斜肌麻痹的外旋斜的手术方式，常需要过矫至内旋5^o左右来代偿术后出现的回退。     

Clinical Features and Surgical Treatment of A-pattern Exotropia

IntroductionAnA鄄patternexotropiashowssignificantlymoreexodeviationindowngazeversusupgaze,inwhichthechangeofbinocularalignmentresemblesthealphaberA.Accordingtopublishedreports[1～4],A鄄patternexotropiaisviewedastheleasttypeofAandVpatterns.However,thepr鄄evalenceofA鄄patternexotropiaratherincreasedinourclinicalstudies[5],inwhichparticularattentionwaspaidtoobservethedeviationindownwardgazeandassesssuperiorobliquefunction.Accordingly,clinicalcharacteristics,surgicaltreatmentandtreatmentoutcome…     

Leptin and asthma in overweight children at 12 years of age

Obesity is suggested as a risk factor for asthma, but the mechanisms are unclear. The relationship between obesity and asthma has not been considered in children born with very low-birth weight (VLBW). We hypothesized that overweight was a contributing factor for asthma in VLBW children, and that leptin and leptin-associated cytokines might play roles in overweight-related asthma. Seventy-four VLBW and 64 normal birth weight (NBW) children participated in a 12-yr follow up study assessing asthma and allergy. Twenty-seven (12 VLBW) of the 138 children were overweight according to the proposed international definition. The diagnosis of current asthma was made by a pediatrician. Serum levels of leptin and interferon (IFN)-gamma were analyzed by enzyme-linked immunosorbent assay (ELISA). Leptin levels were considerably higher in the overweight than in the non-overweight children (median value: 18.1 vs. 2.8 ng/ml, p < 0.001). In the overweight children, current asthmatics had twice as high levels of leptin as children without current asthma (median value: 30.8 vs. 14.3 ng/ml, p = 0.14), but this was not the case in the non-overweight children. IFN-gamma was more often detected in the overweight than in the non-overweight children (61% vs. 12%, p < 0.001), and there was a positive correlation between the levels of leptin and the levels of IFN-gamma (Rho = 0.40, p < 0.001). In the VLBW group, the overweight children had a significantly increased risk for current asthma compared with the non-overweight children after adjustment for the neonatal risk factors [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 1.2-27]. Thus, overweight was associated with asthma in the VLBW children. Our hypothesis remained that leptin might be involved in the pathogenesis of asthma in the overweight children, and IFN-gamma might be a pathway in the process of leptin-induced inflammation.     

Stereotactic radiosurgery for cavernous malformations

OBJECT: The use of stereotactic radiosurgery to treat cerebral cavernous malformations (CMs) is controversial. To evaluate the efficacy and safety of CM radiosurgery, the authors reviewed the experience at the Mayo Clinic during the past 10 years. METHODS: Seventeen patients underwent radiosurgery for high-surgical-risk CMs in the following sites: thalamus/basal ganglia (four patients), brainstem (12 patients), and corpus callosum (one patient). All patients had experienced at least two documented hemorrhages before undergoing radiosurgery. Stereotactic magnetic resonance (MR) imaging was used for target localization in all cases. The median margin radiation dose was 18 Gy and the median maximum dose was 32 Gy. The median length of follow-up review following radiosurgery was 51 months. The annual hemorrhage rate during the 51 months preceding radiosurgery was 40.1%, compared with 8.8% in the first 2 years following radiosurgery and 2.9% thereafter. In 10 patients (59%) new neurological deficits developed that were associated with regions of increased signal on long-repetition time MR imaging performed a median of 8 months (range 5-16 months) after radiosurgery. Three patients recovered, giving the group a permanent radiation-related morbidity rate of 41%. Compared with 31 patients harboring arteriovenous malformations (AVMs) of sizes and in locations similar to those of the aforementioned CMs, who underwent radiosurgery during the same time period, the patients with CMs were more likely to experience radiation-related complications (any complication, 59% compared with 10%; p < 0.001; permanent complication, 41% compared with 10%; p = 0.02). CONCLUSIONS: It is impossible to conclude that radiosurgery protects patients with CMs against future hemorrhage risk based on the available data, although it appears that some reduction in the bleeding rate occurs after a latency interval of several years. The risk of radiation-related complications after radiosurgery to treat CMs is greater than that found after radiosurgery in AVMs, even when adjusting for lesion size and location and for radiation dose.     

葡萄糖酸依诺沙星溶液的稳定性研究

目的考察葡萄糖酸依诺沙星溶液的稳定性。方法采用紫外分光光度法测定溶液中葡萄糖酸依诺沙星含量,HPLC法测定有关物质含量,考察了不同pH值的葡萄糖酸依诺沙星溶液在光照及高温条件下的质量变化。结果葡萄糖酸依诺沙星溶液在光照下易变色pH值5.5～6.0溶液在高温、光照5d后即出现结晶。pH值3.0～4.0溶液在光照条件下含量下降较多,有关物质增加较多。pH在4.0～5.5之间的葡萄糖酸依诺沙星溶液稳定性较好。结论本品应遮光保存,液体制剂的pH值范围确定在4.0～5.5之间较好。     

生殖健康促进

健康促进最早是由医学史家Henry E.Sigerist于1945年提出来的[1]。他指出我们应该通过提供适宜的生活标准,良好的劳动条件、教育、物质文化以及休闲方式来促进健康。目前,普遍为大家所接受的健康促进的定义为“健康促进是促使人们维持和改善他们自身健康的过程[2]。”这个定义是一个包含社会和政治综合性的过程。它不仅仅是加强个人的技能和能力,还包括改变社会、环境和经济的条件来减少它们对大众和个人健康的影响。所以,健康促进是增强人们对健康决定因素的控制能力,从而改善其健康的过程。作为健康重要组成部分的生殖健康同样也受到了…